The Influence Of Different Surgical Plans On Aortic Remodeling After Stanford B-type Aortic Dissection Endovascular Repair

Part I Comparison of Aortic Remodeling Between Chimney Technique and Single-Branched Stent Graft for Treating Patients with Type B Aortic DissectionsObjective: To compare the short-term efficiency and aortic remodeling between chimney method and single-branch graft after endovascular treatment for type B dissection.Methods: From February 2013 to March 2016,a cohort of 43 patients with Type B Aortic Dissection(TBAD)involving the left subclavian artery(LSA)underwent thoracic endovascular aortic repair(TEVAR)in two tertiary medical centers,consisting of 22(Group A)with chimney grafts(CG)and 21(Group B)with single-branched stent grafts.Data of the perioperative and follow-up period(? 3months)were collected and aortic remodeling of the two groups were compared.Results: Endoluminal repair of the two groups was successfully carried out.Technical success was achieved in 22 cases(100%)in Group A and 20 cases(95.2%)in Group B,respectively.During the procedure,one CG compression occurred in Group A and one type I endoleak in Group B.The average follow-up period was 14.6months in Group A and 15.4 months in Group B,respectively.During follow-up,four complications occurred in Group A(two CGs occlusion,one type I endoleak and one death from dissecting aneurysm rupture),compared with two occurred in Group B(one sidearm graft twist and one death from myocardial infarction).The CTA images revealed that complete thrombosis of false lumen(FL)in thoracic aorta was 15 cases(83.3%)in Group A and 17 cases(89.5%)in Group B,and there was no statistically significant difference(P>0.05).In the abdominal aorta,the difference of the complete thrombosis of the FL between Group A and Group B was statistically significant(23.1% vs.36.4%,P<0.05).Significant true lumen re-expansion and false lumen regression were observed in different levels of the aorta by computed tomography angiography(CTA)in both Groups(P<0.05).Neither significant diametric changes nor area changes in all levels of aorta were found between the two groups(P>0.05).Conclusions: For patients with TBAD involving the LSA,the chimney technique and the SBSG revealed comparable results.Further evaluation of more patients with longer follow-up is needed to substantiate these results.Part II Aortic remodeling in Type B aortic dissection after thoracic endovascular aortic repair with an aortic extender cuff implantationObjective This study investigated the safety and effciency of thoracic endovascular aortic repair(TEVAR)plus an aortic extender cuff placement in treating Stanford Type B aortic dissections(TBADs).Methods Clinical data on 157 patients with TBADs who underwent TEVAR in two tertiary medical centers from February 2013 to March 2018 were analyzed retrospectively.An estimated mismatch rate>120% was the indication for placement of an aortic extender cuff.Results in the perioperative and follow-up periods(?3months)were analyzed,especially those of aortic remodeling.Results In total,106 patients(67.5%)underwent standard TEVAR,and 51(32.5%)received TEVAR plus an aortic extender cuff placement.The primary technical success rate was 96.8%(152/157).Perioperative adverse events included endoleak (2%,3/157),spinal cord ischemia(SCI)(1.3%,2/157),and transient renal failure(0.6%,1/157),with no between-group differences.The median follow-up was 15months(range 3–71 months).Ten cases of late stent complications were observed,including three endoleak,one upper limb ischemia,one stent distortion,and five stent graft-induced new entry(SINE).Patients with a cuff had less SINE and fewer second interventions,but the differences lacked significance.In the last follow-up,the TEVAR+Cuff group were found to have better true lumen recovery and false lumen shrinkage,and increased complete false lumen thrombosis in the thoracic and abdominal segments;however,no statistical difference was evident in comparison with the TEVAR group(P>0.05).Conclusion TEVAR plus an aortic extender cuff implantation improves remodeling of the dissected thoracic aorta.The covered stent with a length of 250 mm does not increase the rate of SCI or paraplegia.However,these results should be confrmed in a larger series of patients with longer follow-up.